Healthcare Provider Details

I. General information

NPI: 1497660773
Provider Name (Legal Business Name): SYNERGY BEHAVIORAL HEALTH GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3839 S 63RD DR
PHOENIX AZ
85043-0124
US

IV. Provider business mailing address

8129 W PAMELA LN
PEORIA AZ
85345-4205
US

V. Phone/Fax

Practice location:
  • Phone: 602-903-9136
  • Fax:
Mailing address:
  • Phone: 602-903-9136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. GETE BEKELE EDAE
Title or Position: ADMINSTRATOR
Credential: LPN
Phone: 602-903-9136